Medicare may be complicated, but understanding the basics is crucial. Here are the resources on Medicare that will help you and your staff help your patients:
Glossary of Terms:
Coinsurance: a kind of cost sharing where costs are split on a percentage basis. For example, Medicare Part B pays about 80% and you pick up the rest.
Copayment: a kind of cost sharing where you pay a pre-set, fixed amount for each service. Sometimes called “copay.”
Deductible: a kind of cost sharing where you have to pay a pre-set, fixed amount before Medicare begins to pay for Medicare approved expenses.
Medicare Advantage: see Part C.
Medicare supplement insurance plans: insurance that you buy from a private insurance company that pays for some or all of the cost sharing in Medicare Parts A and B coverage. Medicare supplement insurance is available in up to 10 standardized insurance plans. Each plan is named with a letter of the alphabet. In Massachusetts, Minnesota and Wisconsin there are different standardized plan options available.
Part A: the part of Medicare that provides help with the cost of inpatient hospital stays, skilled nursing services following a hospital stay, hospice, respite care and some home health services.
Part B: the part of Medicare that provides help with the cost of medically necessary services like doctor services, outpatient care and other medical services Part A doesn’t cover.
Part C: Medicare approved private insurance companies offer plans that provide Medicare Part A and Part B services. Part C plans are also called “Medicare Advantage” plans.
Part D: plans from Medicare approved private insurance companies that offer help with the cost of prescription drugs.
Premium: a fixed amount you have to pay for an insurance plan; usually as a monthly payment.
Provider: a person or organization that provides medical services and products, such as a doctor, hospital, pharmacy, laboratory or outpatient clinic.
Here is a straightforward video to help you get your head around Medicare: https://www.aarpmedicaresupplement.com/about-medicare/learn-about-medicare.html
Standardized Medicare Supplement
Medicare Parts A and B work together to provide basic medical coverage, but they don’t pay for everything. Expenses such as deductibles and coinsurance are still your responsibility.
Medicare supplement insurance plans could help pay for some of the out-of-pocket costs that Medicare Parts A and B don’t pay. Medicare supplement insurance plans are offered by private insurance companies and work with the coverage provided through Medicare Parts A and B. A variety of standardized plans are available to meet your budget, and each offer the same basic benefit structure.
Medicare supplement insurance plans may also help you control your health care because there are no network restrictions. This means you can visit any doctor who accepts Medicare patients, and you can see a specialist with virtually no referrals needed.
More about Medicare Supplement Insurance Plans:
In all states, Medicare supplement plans have the same basic benefits. So when shopping for a plan, you can compare one company’s “plan F” to another company’s “plan F.”
Note: Medicare supplement plan options available in Massachusetts, Minnesota and Wisconsin are standardized differently than plans available in the rest of the U.S.
Depending on the plan you choose, Medicare supplement insurance pays:
Part A coinsurance, and most plans pay the hospital deductible
Some of the out-of-pocket costs not paid by Part B. Some plans also cover the Part B deductible
Cost of blood transfusions (first 3 pints)
Cost of 365 extra hospital days after you’ve used up your Part A benefits
Skilled nursing facility coinsurance
Hospice – Part A coinsurance
Depending on the plan you choose, you pay:
Limited out-of-pocket costs
This content came from the AARP site: https://www.aarpmedicaresupplement.com/about-medicare/learn-about-medicare.html
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